Post Course Discussion With Speakers

We would like to introduce something new: a discussion with our speakers following their course. This is the ideal opportunity for course participants to share their experiences using the new techniques learned, and discuss any clinical challenges, solutions and suggestions. We welcome all therapists to offer their own therapy tips and join this community.

The Pediatric Brain:Functional Neuroanatomy and the Sensory Systems and their Treatment Applications

Hello all,

I hope that everyone has had a chance to try some of the treatment strategies that we talked about at my course. I wanted to follow up because some of you had talked with me about your clients and had questions, and I wanted to make sure that everyone’s requests were appropriately addressed. Sometimes there is not enough time through the course of the weekend. If anyone would like to continue discussing their particular clients that were brought up or had any further questions now, or at any point in the future, please do not hesitate to post your questions, thoughts and suggestions on this blog.

I always love to keep communication open and am also eager to learn from all therapists I come into contact with.

Thanks again and hope some of you got to do some reflex testing, adjust some treatment plans, and throw a little vision activity into the mix!

10 Responses to Post Course Discussion With Speakers

I have been talking with my colleagues about the primitive reflexes and we are including them more and more in our treatment and evaluation.

Would you please talk me through the Moro reflex again? In a baby the reflex manifests itself in a whole body extension followed by retraction into flexion…correct?
Could you explain how the testing (toes out and heels out) is a test for the reflex? I understand what reaction we see in an aberrant reflex-are we seeing that because the top and bottom of the body are still
linked?
Could you review the treatment activities? When looking on line I have found several activities for the starfish type exercise. But that looks like you are just repeating the reflex…how does that integrate it?

Thank you. I really did come away with a lot of good info from your presentation. As you know, that can often create more questions. Thanks for being available to answer them.

Heather,
I am responding briefly so that you know I got your question but I need to respond when I have a good 10 minutes to sit down and formulate my thoughts! I will be back in touch soon! Sorry for the delay! Janine

Your question is exactly the same as ones I have asked professionals because it does seem contradictory! I hope I can accurately articulate this.

You are correct about the infant Moro Reflex…with the goal of the reflex being upper and lower limbs moving in unison away from and back to midline. With this integrating, it should disappear allowing for disassociation between upper and lower limbs and easy movement through midline. In the adult, the startle becomes back and neck extension and head turn to the sensory stim (and in me…a giant gasp which drives my husband crazy! :)).

So, when assessing our kids, we are looking at their ability to disassociate upper and lower limbs, and we know that when they can’t that this will also affect free movement through midline. This relates to the test of turning toes in or out and upper body following.

In terms of the starfish activity, it is a precursor task for children that cannot yet do the higher level duck/pigeon walk activities. I’m sure you’ve noticed since doing this that they can’t do the walking activities very well b/c they land up just rotating their feet forward. So starfish is a good place to start b/c it is seated. I realize now that I was misleading with the activity b/c we were on a low bench and had a lot more core activation. If that is too hard, the child can just sit on a regular chair or ball chair and not have to engage the core as much. This can be added as the challenge needs to be increased.

As the child performs the task, the goal is the end point of crossing at midline and being able to motor plan the various positions of hands and feet. Also, consciously moving away from midline into the star position (even though it mimics the reflex it is performed consciously with control and then they consciously have to move out of it). In terms of a hiearchy, the child will

1. cross same side arms and legs (right arm on top, right leg on top). Repeat pattern with only one side.
2. keep same side but do right arm/right leg; then left arm/left leg
3. opposite arm to leg: right arm/left leg..repeat pattern
4. alternating: right arm/left leg; left arm/right leg

I must admit that I do find it hard to just do rote activities like this. I have introduced it a lot in my groups that I do and the dynamic component of the group makes it more exciting. So, this is great as a home program b/c rote is always easier at home…and then in the clinic, knowing that you are working on midline crossing, bilateral integration, and maybe creatively adding “starfish” like movements into the flow of a dynamic session will still benefit the child (more so than not thinking about these movements at all). Of course, I’m not encouraging you to not do the activity at all….just admitting that sometimes things get too rote for me and I like to change it up 🙂

Hope this adds some clarity. We can continue to chat if you have additional questions or any input for me 🙂

Thanks Janine. That is very helpful. As our discussion at work has continued over the previous few days, we came close to some of those conclusions, but I appreciate the clarification. I am fortunate to work with “questioners”, so I may have more questions your way in the future. Is this this best way to contact you or would you prefer a regular email?

Heather,
Did you email me another question to my yahoo that I did not respond to? I know I got a question and started a draft and then mistakenly didn’t finish and send. Wanted to make sure it wasn’t you.
Thanks
Janine

Hi Janine,
I have a few questions that have come up in my new treatment ideas.

1. Do you know if there are any precautions/contraindications of completing linear and rotary vestibular exercises (Astronaut Training) with children with a Shunt?

2. I work in a severe population with students who use AT devices and have limited active movement. I have introduced to some of these students the tracking and smooth pursuits exercises, and would like to continue to develop their visual perceptual and vision skills. These students make choices with switches using various body parts to activate dynamic display devices or make choices. I didn’t know if you knew any programs that would be compatible with a computer or Dynavox to work on visual skills. Any ideas are welcome.

Thank you so much for teaching this course. It has added another element to my treatment sessions that I wouldn’t have focused as much on before! Do you teach any other courses in the Midwest?

These are great questions! Ones that I continue to have and have not found all the answers too.

Regarding the shunt, in the past, and again since you asked the question, I tried to contact vital sounds to get information directly from them but have not yet heard back from them. When it comes to shunts, my first recommendation would always be to consult with the child’s MD. Every situation may be slightly unique depending on the location of shunt, how many potential issues they have had, revisions, time they have had it, etc…so I would always defer to MD first making a very specific request and letting them know that the child would be spun in side lying left and right, and sitting. I consulted with an MD that I used to work with and his response was that he wouldn’t see any issues unless there were a change in atmospheric pressure. However, even with that, this may be an area to take more precautions rather than less b/c you certainly would not want anyone to be able to point to you if anything did happen to go wrong with the shunt during the time you saw the child.

2. Regarding programs, I use a free online website called http://www.eyecanlearn.com. You can google a vision program called Home Therapy Systems. It may be too pricey or too complex for this level of student. I also sometimes just use the simple Paint accessory because you can “draw” at a much slower rate and the child can work on saccades and pursuits that way depending on how you choose to draw. However, you would have to be doing the moving of the mouse….unless they are touch screens in which they would still be working on ocular motor skills. You could do stuff like make simple dot-to-dots, etc.

If I come across more, I will email you again. Hope this helps and let me know what you come across so I can share it with others too.
thanks for contacting me!
take care
Janine

I just wanted to comment that I attended the Pediatric Brain course this past weekend taught by Janine Wiskind. In 15 years of practice I have never attended a course so well presented. She was able to take my least favorite subject and hold my interest for 2 solid days. I couldn’t believe it. She is an excellent speaker. Best course I have ever attended. I look forward to selecting more education resource courses. Finally, not wasting my money!!